Developing a Culture of Successful Communication in Acute Care Settings: Part II. Solving Institutional Issues

Speech-language pathologist involvement in the paediatric intensive care unit

PURPOSE

To measure the prevalence of speech-language pathologist (SLP) involvement and associated trends for critically ill children in United States (US) paediatric intensive care units (PICU) through secondary analysis of the Prevalence of Acute Rehab for Kids in the PICU (PARK-PICU) study data.

METHOD

A secondary analysis of cross-sectional point prevalence study conducted over 1 day in 82 US PICUs. Data collected included SLP presence, patients' age, length of stay, medical interventions, aetiology, admission data, Glasgow Coma Scale scores, staffing involvement, and family presence.

RESULT

Among 961 patients, 82 were visited by an SLP on the study day for a prevalence of 8.5%. Most visits were for children <3 years old. The odds of SLP involvement were lower for children who were 7-12 years old (vs. age 0-2; adjusted odds ratio [aOR] 0.28; 95% CI 0.1-0.8), were mechanically ventilated via endotracheal tube (vs. room air; aOR 0.02; 95% CI 0.005-0.11), or had mild or severe disability (mild vs. no disability; aOR 0.34; 95% CI 0.16-0.76 and severe vs. no disability; aOR 0.39; 95% CI 0.17-0.90). Concurrent physical and/or occupational therapy involvement was associated with higher odds of SLP involvement (aOR 3.6; 95% CI 2.1-6.4).

CONCLUSION

SLP involvement is infrequent in US PICUs. PICU teams should be educated about the scope of SLP practice, to support communication and oral feeding needs during early recovery from critical illness.

Augmentative and Alternative Communication Interventions in Critical and Acute Care With Mechanically Ventilated and Tracheostomy Patients: A Scoping Review

PURPOSE

Communication with nonspeaking patients is a critical challenge of person-centered care. This scoping review aimed to map the literature on augmentative and alternative communication (AAC) interventions for nonspeaking mechanically ventilated and tracheostomy patients in critical and acute care settings.

METHOD

Electronic database, ancestry, and forward citation searches were conducted using eligibility criteria established a priori. Data were extracted, synthesized, and summarized according to scoping review methodology. Studies were categorized by type of intervention and summarized in terms of purpose, participants, design, quality appraisal (including validity and reliability of selected efficacy measures), and efficacy.

RESULTS

Small-to-large treatment effect sizes indicated demonstrable impact on patient health and communication efficacy with high-tech and no-tech visual interface-based interventions and systematic nurse training interventions. Treatment effects primarily pertained to dependent variables of patient anxiety, communication satisfaction, comfort, symptom self-reporting, and nursing practice changes.

CONCLUSIONS

There is a paucity of high-quality AAC intervention research for mechanically ventilated and tracheostomy patients in critical and acute care settings. Emergent evidence suggests that select visual interface and nurse training interventions can impact efficacy of patient-provider communication and patients' overall health.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.26506102.

Ensuring communication access for all during the COVID-19 pandemic and beyond: supporting patients, providers, and caregivers in hospitals

The COVID-19 pandemic has revealed substantial gaps in communication access for patients across hospital settings. With the rise in positive cases globally, the need for communication enhancement strategies, including augmentative and alternative communication (AAC), has emerged as a critical need. Many resources exist that describe AAC assessment and intervention processes in the acute care setting; however, AAC service provision in the COVID-19 pandemic is fraught with many unanticipated challenges. Patients, providers, and caregivers have encountered significant communication strain both at the bedside and beyond hospital walls, resulting in a communication crisis induced by many COVID-19 related variables. This article describes the sequelae of symptoms a person with COVID-19 may experience, progression of communication needs, and evidence-based solutions to supporting communication access. Barriers related to the COVID-19 pandemic are outlined (e.g., evolving infection control practices, personal protective equipment requirements, visitor policies, and more) along with response recommendations to support communication enhancement efforts for people with and without COVID-19 benefiting from access to AAC.

Forum on Augmentative and Alternative Communication in Acute Care

This forum provides some insights into the process of initiating a clinical service to enhance patient- provider communication. It also provides a report of a large-scale clinical trial that introduced augmentative and alternative communication (AAC) tools in an acute-care setting.